Provider Demographics
NPI:1316939358
Name:BLACK, ARTHUR DEWAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:DEWAYNE
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-762-3993
Mailing Address - Fax:228-762-3839
Practice Address - Street 1:2725 ANDREW AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-1815
Practice Address - Country:US
Practice Address - Phone:228-762-3993
Practice Address - Fax:228-762-3839
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS15591207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118736Medicaid
MS210017000OtherUSDOL
MS$$$$$$$$$DOtherBLUE CROSS
MS210017000OtherUSDOL
MS00118736Medicaid